Multiplicity of infections and level of recrudescence in Plasmodium falciparum malaria in Mlimba, Tanzania

Polymorphism and antigenic variation are important biological survival strategies of malaria parasites determining the episode, outcome and implications of treatment interventions. In P. falciparum, polymorphic antigens are associated with the asexual blood-stage; merozoite surface protein 2 (MSP2). The MSP2 genes have been invaluable in post-treatment discrimination of parasite resurgence from new infection, especially in high transmission areas. We performed polymerase chain reaction (PCR) on DNA extracted from blood samples of 141 malaria-infected infants, followed by restriction fragment length polymorphism (RFLP) of PCR products. The findings showed multiplicity of infections of single to six infections with an average of 2.58 infections per patient. Single infections of either 3D7 or FC27 allelic families of the MSP2 gene occurred in 51 patients (50.5%) out of all PCR-RFLP successful samples (n = 101). Out of 15 (10.6%) follow up samples with resurgent parasitaemia, 3 (20%) samples had recrudescent infections while 12 (80%) had variable results. Our findings provide an insight on the prevalence of the genetic determinants of suphadoxine-pyrimethamine (SP) resistance in Mlimba during the study period, and in the face of rapidly spreading resistance, calls for the periodic surveillance in order to timely detect early warning signal of the deteriorating SP cure rate.